{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T17:17:01Z","timestamp":1772471821900,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Post-induction hypotension (PIH) is common in emergency spine surgery and may vary by time of day. We evaluated whether a personalized hemodynamic management (PHM) bundle was associated with reduced PIH and hypotension burden. Materials and Methods: We conducted a single-center retrospective pre\u2013post cohort study of adults undergoing emergency decompressive or stabilizing spine surgery under general anesthesia. The PHM bundle included documentation of an individualized pre-induction MAP target (default 65 mmHg; higher for selected high-risk phenotypes), dynamic assessment of fluid responsiveness, and proactive vasopressor use (norepinephrine initiated at induction in prespecified high-risk patients), with continuous BP trajectory monitoring. PIH was defined as mean arterial pressure (MAP) &lt; 65 mmHg or a \u226530% decrease from pre-induction MAP within 20 min. We used 1:1 propensity score matching (caliper 0.2) and provider-clustered logistic regression in the matched cohort. Results: Among 312 eligible patients (usual care n = 200; PHM n = 112), PIH varied by time of day, with the highest incidence in morning cases (46.2%; p = 0.041). After matching, 224 patients (112 per group) were analyzed. PHM was associated with lower PIH (43.8% vs. 33.0%; adjusted odds ratio 0.62; 95% CI: 0.41\u20130.94; p = 0.024). PHM reduced time-weighted average (TWA) MAP below target (5.7 \u00b1 4.2 vs. 3.2 \u00b1 3.6 mmHg; mean difference (MD) \u22122.3 mmHg; 95% CI \u22123.3 to \u22121.3; p = 0.001) and area under MAP &lt; 65 mmHg (ratio 0.62; 95% CI 0.50\u20130.78; p &lt; 0.001). Norepinephrine-equivalent dose was higher (\u0394 + 20 \u03bcg; p = 0.005) while rescue phenylephrine boluses were fewer (\u0394 \u2212 1; p &lt; 0.001); crystalloid volume was similar (p = 0.151). Conclusions: In emergency spine surgery, PIH showed time-of-day variation, and PHM implementation was associated with reduced PIH and hypotension burden.<\/jats:p>","DOI":"10.3390\/medicina62030473","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:06:59Z","timestamp":1772467619000},"page":"473","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time-of-Day-Dependent Post-Induction Hypotension and Personalized Hemodynamic Management in Emergency Spine Surgery: A Retrospective Pre\u2013Post Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2472-2908","authenticated-orcid":false,"given":"Cheol","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk-do, Republic of Korea"},{"name":"Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk-do, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunsung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan-si 54538, Jeonbuk-do, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1969-860X","authenticated-orcid":false,"given":"Jina","family":"Kim","sequence":"additional","affiliation":[{"name":"Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk-do, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4932-7884","authenticated-orcid":false,"given":"Kwangjin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk-do, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1213\/01.ANE.0000175214.38450.91","article-title":"Predictors of hypotension after induction of general anesthesia","volume":"101","author":"Reich","year":"2005","journal-title":"Anesth. Analg."},{"key":"ref_2","first-page":"7044","article-title":"A systematic review of risk factors for postinduction hypotension in surgical patients undergoing general anesthesia","volume":"25","author":"Chen","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/bja\/aex127","article-title":"Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia","volume":"119","author":"Brechnitz","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e46451","DOI":"10.1097\/MD.0000000000046451","article-title":"Incidence and risk factors for perioperative hypotension during noncardiac surgery: A retrospective cohort study","volume":"105","author":"Sun","year":"2026","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00464-022-09758-x","article-title":"Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons","volume":"37","author":"Irani","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111984","DOI":"10.1016\/j.jclinane.2025.111984","article-title":"Differences in incidence of post-induction hypotension depending on the time of day: A post-hoc propensity score matched analysis","volume":"107","author":"Tol","year":"2025","journal-title":"J. Clin. Anesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1056\/NEJM199110033251402","article-title":"Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity","volume":"325","author":"Panza","year":"1991","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"20541","DOI":"10.1073\/pnas.1006749107","article-title":"Impact of the human circadian system, exercise, and their interaction on cardiovascular function","volume":"107","author":"Scheer","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1161\/ATVBAHA.119.312682","article-title":"Circadian Rhythm of Vascular Function in Midlife Adults","volume":"39","author":"Thosar","year":"2019","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_10","first-page":"334","article-title":"Personalized hemodynamic management","volume":"23","author":"Saugel","year":"2017","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"187s","DOI":"10.1177\/21925682231202348","article-title":"A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on Hemodynamic Management","volume":"14","author":"Kwon","year":"2024","journal-title":"Glob. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1001\/jama.2017.14172","article-title":"Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial","volume":"318","author":"Futier","year":"2017","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1001\/jama.2025.18007","article-title":"Proactive vs Reactive Treatment of Hypotension During Surgery: The PRETREAT Randomized Clinical Trial","volume":"334","author":"Kant","year":"2025","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e287","DOI":"10.1161\/CIR.0000000000001024","article-title":"Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association","volume":"144","author":"Ruetzler","year":"2021","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/BRS.0000000000005030","article-title":"Intraoperative Hypotension Is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery","volume":"50","author":"Glassman","year":"2025","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/BRS.0000000000005121","article-title":"Impact of Predictive Hemodynamic Monitoring on Intraoperative Hypotension and Postoperative Complications in Multi-level Spinal Fusion Surgery","volume":"50","author":"Carreon","year":"2025","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.1038\/s41598-025-33740-x","article-title":"A time-series clustering analysis of postinduction blood pressure trajectories","volume":"16","author":"Glebov","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s00586-018-5848-x","article-title":"After-hours\u2019 non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center","volume":"28","author":"Flexman","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1213\/ANE.0000000000007074","article-title":"Intraoperative Hypotension in Patients Having Major Noncardiac Surgery Under General Anesthesia: A Systematic Review of Blood Pressure Optimization Strategies","volume":"141","author":"Lee","year":"2025","journal-title":"Anesth. Analg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Carreon, L.Y., Glassman, S.D., Chappell, D., Djurasovic, M., Mathew, J., Ward, T., and Gum, J.L. (2025). Continuous Intraoperative Hemodynamic Monitoring Decreases In-hospital Costs. Spine.","DOI":"10.1097\/BRS.0000000000005373"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/473\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:47:57Z","timestamp":1772470077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030473"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030473","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]}}}